Disease Spotlight: Atrial Fibrillation

According to the ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation (AF), over the past 20 years there has been a 66% increase in hospital admission for AF due to an aging population and a rising prevalence of chronic heart disease. Of the 466,750 deaths due to disorders of heart rhythm, AF and flutter mortality rates totaled 11,555 with a reported prevalence of greater than 2.2 million. The lifetime risk for development of AF is one in six and as high as one in four for men and women 40 years of age and older. What makes AF so clinically and economically costly is the fact that it increases the risk of stroke five-fold. AF is responsible for between 15 and 20 percent of all strokes, which account for one in 17 deaths in the United States, and ranks third among all causes of death, behind heart disease and cancer.

Similar to the trends reported in the 2006 guidelines document, in March two-thirds of CardioSurve panelists (64%) reported the incidence of AF on the rise and approximately one out of five (18%) of their patients being treated for AF. Stroke prevention, followed by rate control, was the most popular way of treating AF.

In the study, cardiologists expressed confidence in their ability to treat AF using cardioversion, anti-coagulation strategies, rate control, pharmaceutical therapies and rhythm control. They said that they were less confident in their understanding of cardio-ablation and cardio-mapping techniques. Pharmacological, rhythm, anti-coagulation and ablation treatments are areas that panelists said they would like to expand their knowledge.

The top three sources for clinical education on AF are print journals, newsletters and monographs (83%), followed by in-person attendance at national meetings, grand rounds and other local meetings (69%), and educational/informational websites (62%).

These findings suggest an opportunity for educators as evidenced by a desire for education. The largest learning gaps are in cardiac mapping, cardio-ablation, pharmacologic treatments and rhythm control. Clearly, these are areas in which cardiologists would most benefit from relevant education linked to strategies to overcome barriers such as anti-coagulation and pharmacological challenges, as well as patient compliance.